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Barbara S Taylor¹, Kaku So-Armah, Janet P Tate

¹*Medical Service/Infectious Diseases, South Texas Veterans Health Care System, San Antonio, TX; Department of Medicine, UT Health San Antonio, San Antonio, TX;†Department of Medicine, Boston University School of Medicine, Boston, MA;‡Section of General Internal Medicine, VA Connecticut Healthcare System, West Haven, CT; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT;§Medical Service, VA Medical Center, Atlanta, GA; Medical Service, Emory University School of Medicine, Atlanta, GA;‖Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN;¶Department of Medicine, Infectious Diseases Section, VA North Texas Health Care System; UT Southwestern Medical Center, Dallas, TX;#Center for Health Equity Research and Promotion, VA Pittsburg Healthcare System, Pittsburgh, PA; Hamad Healthcare Quality Institute, Hamad Medical Corporation, Doha, Qatar; Department of Medicine, Weill Cornell Medical College, Doha, Qatar and New York, NY;**Medical Service/Infectious Diseases, VA Medical Center, Washington, DC; Department of Medicine, George Washington University Medical Center, Washington, DC;††Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA;‡‡Infectious Diseases Section, Michael E. DeBakey VA Medical Center, Houston, TX; Infectious Diseases Section, Baylor College of Medicine, Houston, TX;§§VA Connecticut Healthcare System, West Haven, CT;‖‖Cell and Molecular Biology Department, John A. Burns School of Medicine, University of Hawaii- Manoa, Honolulu, HI;¶¶Philadelphia VA Medical Center, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, VA;##Division of Infectious Diseases, Columbia University Medical Center, New York, NY;***Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA;†††Departments of Pathology and Laboratory Medicine and Biochemistry, College of Medicine, University of Vermont, Burlington, VT; and‡‡‡Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN; Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN.

Journal of Acquired Immune Deficiency Syndromes (1999)

|July 12, 2017

Abstract

Objectives:

Obesity prevalence among people living with HIV (HIV+) is rising. HIV and obesity are proinflammatory states, but their combined effect on inflammation (measured by interleukin 6, IL-6), altered coagulation (D-dimer), and monocyte activation (soluble CD14, sCD14) is unknown. We hypothesized inflammation increases when obesity and HIV infection co-occur.

Methods:

The Veterans Aging Cohort Study survey cohort is a prospective, observational study of predominantly male HIV+ veterans and veterans uninfected with HIV; a subset provided blood samples. Inclusion criteria for this analysis were body mass index ≥ 18.5 kg/m and biomarker measurement. Dependent variables were IL-6, sCD14, and D-dimer quartiles. Obesity/HIV status was the primary predictor. Unadjusted and adjusted logistic regression models were constructed.

Results:

Data were analyzed for 1477 HIV+ and 823 uninfected participants. Unadjusted median IL-6 levels were significantly higher and sCD14 levels significantly lower in obese/HIV+ compared with nonobese/uninfected (P <0.01 for both). In adjusted analyses, the odds ratio for increased IL-6 in obese/HIV+ patients was 1.76 (95% confidence interval: 1.18 to 2.47) compared with nonobese/uninfected, and obesity/HIV+ remained associated with lower odds of elevated sCD14. We did not detect a synergistic association of co-occurring HIV and obesity on IL-6 or sCD14 elevation. D-dimer levels did not differ significantly between body mass index/HIV status groups.

Conclusions:

HIV-obesity comorbidity is associated with elevated IL-6, decreases in sCD14, and no significant difference in D-dimer. These findings are clinically significant, as previous studies associated these biomarkers with mortality. Future studies should assess whether other biomarkers show similar trends and potential mechanisms for unanticipated sCD14 and D-dimer findings.

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